increasing regional specialist staff in 1967 are: (a) medical services, and (b) administrative and fiscal methods. (a) Improving medical services.-Bureau staff at the regional level must provide continuing day-to-day leadership and technical assistance to the States in the content and administration of their medical services program. Additional staff are needed to (1) assist in defining acceptable standards of medical care services and to promote their widespread use; (2) provide technical medical consultation and advice to State officials concerned with standards of medical care services; (3) evaluate the effectiveness of State medical care programs; (4) evaluate the reasonableness of fee schedules; and (5) emphasize the importance of evaluating quality of care, economy, and effectiveness of the representative programs. An increase of five positions-three professional and two clerical-is requested for this area in 1967. (b) Improving State administrative and fiscal methods.-There has been a very substantial increase in the responsibility and complexity of State public assistance operations as a result of successive legislative changes in recent years. The establishment of title XIX, as well as the other requirements with respect to payments under the new amendments, creates additional responsibilities. Administrative and fiscal operations and methods need strengthening in every State. The Bureau needs to extend and intensify its technical assistance to the States to assure that the most economical and effective methods possible are used in program operations. It is believed this need can be met most effectively with the assignment of additional administrative and fiscal specialists to the regions. This staff would carry responsibilities for a wide range of functions relating to improved State and local administration, including assistance to the States on use of ADP equipment. An increase of four positions-all professional-is requested for this work. These four positions would also enable the Bureau to complete the assignment of one specialist position of this type to each of the HEW regional offices. CIVIL RIGHTS COMPLIANCE ACTIVITIES (INCREASE OF 25 POSITIONS) Under policies established by the Department of Justice and the Office of the Secretary, continuing and additional priority attention must be given to compliance activities related to the administration of title VI of the Civil Rights Act of 1964. Such activities will also be carried on by the Bureau within guidelines and leadership provided by the Office of the Commissioner. Under the public assistance and other welfare programs, it is important to assure that all needy persons receive assistance without discrimination. Because clients of public assistance programs receive services from a broad range of public welfare, child care, and health service institutions, clinics, and practitioners, there is a heavy responsibility to determine that the programs supported by grants are being conducted in compliance with the provisions of title VI. Program staff, both at the regional and headquarters levels, must be deeply involved with this aspect of the administration of programs. However, in order to accomplish these duties in the most effective manner possible, it is necessary to have a nucleus of civil rights specialists to provide a focus for efforts to emphasize civil rights aspects of the administration of welfare, medical assistance, and related programs. This staff will translate overall policies and guidelines into operational terms; will consult with, and offer technical assistance to, States and other agencies with the aim of producing the highest possible degree of voluntary compliance; will conduct compliance surveys of welfare agencies and institutions; will cooperate with the Public Health Service in conducting compliance reviews of hospitals, nursing homes, and home health services; will investigate complaints from the field; and will participate in training programs for staff related to the administration of title VI responsibilities. Twenty-five positions are requested for this purpose. This will provide seven positions at headquarters to coordinate and direct these programs and to maintain necessary records and prepare reports, and through the Office of the Commissioner, provide a point of liaison with the Office of the Secretary. Eighteen positions will be placed in regional offices to work in cooperation with regional staff on consulting with States and other agencies and institutions, conducting compliance surveys, and investigating complaints. RELATED AREAS OF WORK The inquiry and information functions of the Bureau are a major area of work under this activity. The production of informational releases, special articles, exhibits, etc., must be accelerated in 1967 to keep abreast with the growing demands for interpretive materials on public assistance. Requests from all forms of news media on specific and general program subjects are expected to continue to increase. It is also evident that inquiry mail is another area where the Bureau must anticipate heavy workload. These inquiries come from Members of the Congress, the general public, and potential and current recipients of public assistance; many come directly to the Bureau, and many others are referred from virtually every part of Government. Examples of other work covered by this budget activity include (1) assembly, maintenance, and publication of program characteristics of State plans; (2) grants processing; (3) administration of the program of assistance for repatriated U.S. nationals; (4) review and evaluation of demonstration projects under section 1115 of the Social Security Act; and (5) serving as Bureau focal point in connection with the Civil Rights Act. Workload in each of these areas continues to increase. The increase of $112,105 requested for this activity in 1967 provides for net annualization funds of $69,900 for continuation of the 1966 budget and $42,205 for six new positions in 1967. This activity includes: (1) A national factfinding program carried out through the collection of periodic statistics from the States; (2) special studies designed to produce information needed only occasionally, or on a more comprehensive scale than periodic statistics provide; (3) analysis of trends, interprogram relationships, and other demographic, social, and economic data; and (4) development of information and analyses for use in program planning, policy formulation, and legislative considerations. The staff under this activity make up the only resource in the Bureau for public assistance research projects. Increased emphasis must be placed in 1967 on each of the areas of work identified above to meet the most basic needs for data on financial, medical, and social services and related subjects such as State and local public assistance manpower. To help handle the increasing workload, the periodic statistical reporting system must be (1) reassessed in terms of purpose, periodicity, methods, processing techniques, etc., and (2) revised to maximize the analytical value and improve the effectiveness at the lowest cost possible; examination must also give account to such factors as new demands for information, capacity of State and local agencies to produce the data, and the increased use of sampling. In 1967 the Bureau must also accelerate its use of EDP equipment for data collected from the States-this includes attainment of increased programing ability. It is planned to design and release several major new studies in 1967: Characteristics of AFDC recipients; public welfare personnel; benchmark data on medical care; fiscal analysis of State and local ability to finance public assistance. Examples of other work planned for 1967 include: Development of information on State and local public assistance expenditures by major function and object (for administration, services, and training); development of information for each State on selected quantitative measures (e.g., work performance, progress in implementing the 1962 amendments, maintenance assistance standards, State fiscal effort, and statewideness of various program elements). The increased activity discussed above, the complex nature of the program, and the volume of new medical data that must be collected and analyzed make it imperative that the Bureau have additional staff if demands for program facts are to be met. An increase of six positions-four professional and two clerical-is requested for 1967. The decrease of $108,825 for this activity in 1967 reflects the net effect of (a) a reduction of $172,000 due to nonrecurring expenses included in the 1966 estimate for such items as the administrative survey of the Bureau, other contractual services for visual aids, internal training activities, etc., and (b) an offsetting increase of $63,175 which includes net annualization funds of $25,000 for continuation of the 1966 budget and $38,175 for five new positions in 1967. Continuing responsibilities in coordinating and directing Bureau activities are indicated in the scope of the work included under the foregoing major program activities. Other bureauwide administrative activities include: Budget administration, administrative accounting and auditing, and other financial management functions; personnel management; general services (including records management); and other management functions, such as forms control, work planning and reporting, committee management and management appraisal activities. In addition to emphasis placed by the director's office on achieving better administration of the Federal-State programs, considerable attention will continue on making internal Bureau operations as effective and productive as possible with minimum manpower. Bureau responsibilities and workload have increased rapidly in recent years; there is an acute need to study the effectiveness of present Bureau organization, work processes, and related administrative methods to assure that resources available to the Bureau make a maximum contribution to effective management of program responsibilities. During the latter half of fiscal year 1966, it is planned to request an outside management firm to make a survey of various aspects of Bureau management. Recommendations from the survey will be utilized to streamline and improve the Bureau's administrative framework wherever necessary to enable it to meet the demands of today's public assistance programs as effectively as possible. The comprehensive work which must be undertaken on the report of the Advisory Council on Public Welfare is another example where sustained attention by the director's office will be required in 1967. Internal Bureau staff development is another activity which is being emphasized to assure the best utilization of professional and facilitating staff. The Bureau has a coordinated, intensive training program that endeavors to reach all new employees as well as other staff. Increase of five positions.-The Bureau does not have staff for long-range planning that should be undertaken on the complex of Federal-State programs for which it is responsible. Funds are requested for five positions (three professional and two clerical) for the establishment of a high-level program planning and analysis staff responsible for installation of a system for long-range planning and evaluation of program effectiveness. This staff, advisory to the Direc tor, would permit the relating of resources to problems and would be responsible for conducting continuing analysis of operations to evaluate accomplishments to goals. The staff would provide the focal point for the development of realistic statements as to program goals and identification of criteria for the measurement of progress. This would include the development of a system for provision of management data necessary for decisions in planning operations. The staff would engage in regular quantitative analysis of operational and subprogram activities not only to measure performance against plan but to ascertain cost effectiveness and to develop alternate courses of action to achieve objectives. THURSDAY, MARCH 10, 1966. CHILDREN'S BUREAU WITNESSES MRS. KATHERINE B. OETTINGER, CHIEF, CHILDREN'S BUREAU ARTHUR J. LESSER, M.D., DEPUTY CHIEF, CHILDREN'S BUREAU GORDON FORTNEY, ADMINISTRATIVE OFFICER DR. ELLEN WINSTON, COMMISSIONER OF WELFARE ROY L. WYNKOOP, EXECUTIVE OFFICER, WELFARE ADMINISTRATION ELMER W. SMITH, DEPUTY EXECUTIVE OFFICER, WELFARE ADMINISTRATION JAMES P. CARDWELL, DEPARTMENT DEPUTY COMPTROLLER 4. Research, training, or demonstration projects in child welfare. 5. Special project grants for maternity and infant care. 34, 469 45,000 50,000 34,545 45,000 50,000 33,859 40.000 46,000 6. Special project grants for health of school and preschool children. |